Fatty liver disease has been estimated to affect about 25.2% of the population worldwide. Non-alcoholic fatty liver disease or NAFLD is often a precursor to colon cancer making it common practice now to screen all fatty liver diagnosis for bowel cancer.
What is NAFLD?
Fatty liver is just that. The normal cells of the liver have been replaced with fat cells that cannot do the job of a liver cell. Thus, the total mass of the liver is decreased which impacts the quality of job a liver can do which is to filter the blood coming from the gastrointestinal tract and to detoxify toxins from food, the environment and from oxidative stress within the body.
Weighing in at 3 lbs., the liver is the workhorse of the digestive system and performs over 500 functions to keep the body healthy.
What Causes NAFLD?
Most chronic diseases are impacted by lifestyle choices and NAFLD is no exception. The primary aggravators of fatty liver disease are:
Knowing the causes and contributors of fatty liver disease help practitioners in individualizing a comprehensive care plan to reverse the disorder. Although no established treatment protocol exists for NAFLD, several treatments have shown to reverse the damage and restore healthy liver functioning again. Specifically, there are ten different approaches to restoring the liver to a healthy metabolic balance.
1. Losing weight
Excess weight causes inflammation and insulin resistance, both contributors to fatty liver disease. Studies show that a weight loss of just 10% can dramatically improve NAFLD indicators and function. Even losing 3-5% of one’s body weight can improve liver function and insulin sensitivity.
With exercise there is an increase in fatty acid oxidation (thus taking it out of the liver), improved insulin sensitivity in the cells, decreased fatty acid synthesis and a reduction in liver and mitochondrial damage. Mitochondria are the powerhouses of the cell and the main determinant of our metabolic rate (in conjunction with the thyroid). Physical exercise remains a powerful keyway to reversing fatty liver disease.
The American Heart Association recommends 150 minutes of cardiovascular exercise per week. Or, 75 minutes of vigorous physical activity per week will produce the same beneficial results. Even handicapped and elderly individuals can participate in low impact exercise such as sitting exercises, walking, aqua therapy, Tai Chi, or other creative forms of movement.
Berberine is an herbal extract that has been used successfully to decrease blood glucose and cholesterol in studies where berberine was compared to pharmaceutical interventions. Recent studies have shown it to be beneficial in NAFLD although more research is needed to determine effective dosage.
Berberine promotes fatty acid oxidation, inhibits fat generation and positively alters gut microbes. It has been used as a pharmacological replacement for Metformin ( a standard glucose lowering drug) and for statin medications (used for cholesterol reduction) with great outcomes.
Berberine is safe with few, if any, side- effects aside from some mild gastrointestinal discomfort occasionally reported.
Dosage of Berberine most effective has been found to be 500 mg three times daily.
4. Omega-3 fatty acids
Studies have shown the administration of omega-3 fatty acids to improve liver enzyme levels, normalize blood triglycerides, lower the enzyme GGT, increase HDLs and to decrease fat in the liver. These are all positive changes indicative of liver regeneration. Recent studies suggest that treatment with omega-3 fatty acids may be a new pharmacological approach due to their positive impact on liver inflammation, fibrosis and liver injury.
Studies using omega 3 supplements have achieved positive results with 450 mg – 4 gms/day. Most studies use 1 gram twice per day of omega-3 fatty acids to achieve effects while avoiding fishy aftertastes or unpleasant gastrointestinal upset.
Foods high in omega 3 fatty acids include salmon, sardines, flaxseeds and walnuts.
5. Milk Thistle
In a recent study the obtained results indicated that silymarin (milk thistle) appears to be effective in reducing the biochemical, inflammatory and ultrasonic indices of hepatic steatosis. Some parameters indicative of early stage of atherosclerosis were also lowered.
Milk thistle also decreased insulin resistance.
The most effective dose to achieve liver improvement is 420 mg/day.
6. Beet root
Beet root is effective due to its betaine content which is known to control the inflammation and fibrotic changes within the liver. Beet root is also super high in antioxidants and nutrients aside from the betaine content.
Beets can be enjoyed as a food or purchased as a food supplement. It comes as a powder to make beet juice or in capsules in the root form. Beetroot juice 80-140 ml daily or 200 grams baked or simmered beets can be used for therapy.
Increasing nutritional fiber has been shown to reduce liver enzymes and improve fatty liver infiltration. Increasing vegetables and complex carbohydrates should help, but if on a weight loss program and especially if constipation is a problem a fiber supplement may be in order.
PGX is a water-soluble fiber that can be taken before or with meals to increase satiety, decrease blood sugars and fats and positively affect the liver. If FODMAPS are a problem, taking Benefiber might be a better choice and two servings a day provide only 6 grams of fiber – not enough to cause the common side effects of adding a fiber supplement of bloating and gas.
The fiber recommendations for NALFD are at least 21 grams per day. Dosing should start low and go slow to avoid bloating and cramps.
8. High Fructose Corn Syrup
Fructose is poorly metabolized in NAFLD. Foods high in fructose should be limited. Fresh fruits can be limited to two per day. Sugar, which is part fructose and glucose also needs to be avoided due to the fructose content. Then there is high fructose corn syrup, an additive in pop and many processed foods. Avoid at all costs. Read labels but do not consume high fructose corn syrup.
High fructose corn syrup (HFCS)-containing beverages were associated with metabolic abnormalities and contributed to the development of NAFLD in human trials. Ingested carbohydrates are a major stimulus for hepatic de novo lipogenesis (DNL) and are more likely to directly contribute to NAFLD than dietary fat.
9. Vitamin D
New evidence suggests that low serum Vitamin D may cause nonalcoholic fatty liver disease (NAFLD). Low Vitamin D is associated with the severity and incidence of NAFLD.
A test of vitamin D status should be run on every patient with a diagnosis of NAFLD. Furthermore, levels less than 30 should be repleted with supra-optimum doses for a period such as the repletion protocol of 10,000 IU for 5 days for 6 weeks and then retest and adjust dosage.
10. Emphasis on low glycemic index carbohydrates
A low glycemic Mediterranean type diet was found to decrease the indicators of fatty liver in a short amount of time in a recent randomized clinical trial. It was concluded that this type of intervention should be pursued as part of all lifestyle interventions for NAFLD.
Many of these changes are fairly easy but some may require some education. Don’t be afraid to reach out to your Registered Dietitian for guidance on how to make these changes.
#NAFLD, #berberine, #fattyliver, #lowglycemic, #HFCS, #vitaminD, #beetroot, #milkthistle
Alzheimer’s Disease (AD), a brain disorder that ravages your memory, robbed 5.5 million Americans of their quality of life in 2019. Two-thirds of those affected were women, the traditional caretakers of our society. African Americans are twice as likely as Caucasians to be diagnosed with this illness and there is no cure. But there is hope.
Research is showing that diet may delay the signs and symptoms of Alzheimer’s Disease and we all know that every moment we can spend with our loved one where we don’t have to wrestle with the side-effects of this disease are precious and to be treasured.
Studies from Rush University in Chicago have found that the MIND diet, a combination of the DASH diet and the Mediterranean diet, may decrease the risk of Alzheimer’s by as much as 50% and can still protect the brain even when not followed rigorously.
What is the MIND Diet?
The MIND diet was born out of blending the DASH diet for hypertension which focused on limiting sodium in the diet while increasing vegetables and low fat dairy with the Mediterranean diet, a diet focused on increasing vegetables, monounsaturated fats from olive oil, fish, whole grains and omega 3 fatty acids.
Researchers believe that those who follow the diet for years will receive the greatest protective benefits. The time to start a MIND diet is when you find out you have Alzheimer’s Disease in the family as it will lower your risk of developing it. For those who already have it, its not too late to start the diet to delay the progression of AD.
What Does the MIND Diet Do?
The MIND diet emphasizes those foods that protect the brain and restricts those foods that affect the brain adversely. It works because it reduces inflammation of the brain and nerves, it acts as an antioxidant for the tissues, it makes nerve transmission more fluid and decreases neuron loss while improving memory overall.
How Do I Follow a MIND Diet?
As with any major change, start slow. Make a few changes at a time until the MIND diet feels like your normal routine. Soon even grocery shopping will become automatic and you won’t have to pour over lists of foods that you aren’t used to eating or learn new recipes or ways of cooking because it has become a habit. It just takes a little time, one step at a time.
When introducing starchy beans into the diet, do so slowly if it is a new food to the individual. Starchy beans like chickpeas, lentils, kidney beans, fava beans, etc., are not only high in fiber, they may be gas forming and cause bloating if introduced into the diet too quickly. Always introduce increased fiber slowly with 8 glasses of water per day to avoid bloating.
Another trick to lessen gas and bloating from beans is to either soak them overnight, drain and rinse or bring to a boil and drain, rinse and then bring the beans to heat again. Draining the water gets rid of the gassy component present in beans.
Also, some healthy foods can be expensive, a real consideration for most of us. One way to save money is to buy fruits and vegetables in season and freeze them. Don’t use sugar or salt, just freeze them after they’ve been cleaned, label and date them and freeze for later.
MIND Diet Guidelines
The Rules of the Diet Are:
The MIND diet supports vascular health and is protective against vascular dementia. Certain foods used in the MIND diet have been directly linked to improved neurological function or reduced Alzheimer Disease biomarkers in the brain. MIND diet foods reflect nutrients that have been shown in studies to slow cognitive decline, decrease the risk of AD, scour the brain of amyloid plaque and decrease neuron loss.
So, while a cure may not be here, hope is on the horizon for a better quality of life by following the MIND diet.
#Alzheimer's Disease #MIND diet #cognitive #dementia
What is Evidence-Based Medicine?
Defined, evidence-based medicine is the cumulative result of a synthesis of clinical expertise, patient’s values and the best scientific evidence we have available relative to that patient’s care. Evidence-based medicine (EBM) originated in the second half of the 19th century and represents the conscientious use of the best evidence available in making reasonable decisions about patient care.
Gaps Between Research and Practice in Medicine
One of the biggest shortcomings of using EBM is the gap between the release of scientific studies and their adoption by the clinical community. It represents a huge knowledge gap and a barrier to the implementation of the EBM model. For example, in the case of the beneficial use of aspirin in the treatment of heart attack victims, it took almost a decade for it to become a routine practice after the EBM studies were released.
Interestingly, the publication of COVID-19 articles are bypassing some of the usual publication rules and are going right into the search engines. This is to specifically reduce the gap between research and practice, an endeavor much needed in this pandemic.
Classification of Evidence
EBM classifies evidence based on their freedom from biases in the interpretation of the results. The levels of evidence look something like this:
1. Evidence obtained by a meta-analysis of several randomized controlled research (RCR).
2. Evidence from a sole RCR.
3. Evidence from one well designed controlled RCR.
4. Evidence from one quasi-experimental approach.
5. Research case study only.
6. Evidence from one’s clinical practice or case studies.
Each level represents a strength of evidence to ponder in application to a patient’s case or to a public health situation. With EBM a provider can assess the strength of evidence with the risks/benefits of ordering tests and treatments for an individual patient or the strength of evidence for a public health recommendation. We are said to be in an age of EBM.
Five Ways Evidence-Based Medicine Adds Value to the Functional Health Model
1. EBM helps functional health providers stay on top of standardized treatment protocols without reading 17 studies a day by utilizing study classification and priority.
2. Uses timely data to make decisions. This has been greatly aided by the computer age and the development and maintenance of large databases of information that providers can access for research and education.
3. It improves accountability, transparency, and worth. What this means is the patient acquires the best care for the least cost with all variables of the treatment consistent with the values of the patient.
4. Improves the quality of care. Despite the fact that Americans spend more money on healthcare than any other nation in the world, we are the sickest.
5. Improves outcomes. Functional health providers are invested in practicing medicine that works, not just seeing patients on a daily schedule and taking care of urgent ills. They want to see that a prescribed treatment has true value for a patient and that the care received has made a significant impact on that patient’s overall health and well-being.
Functional health represents a fusion of EBM and alternative medicine. It has been argued that functional health practitioners are not evidence-based practitioners. That cannot be further from the truth. Functional health practitioners frequently rely on EBM for treatment decisions and novel approaches to diseases that are on the cutting edge of scientific decisions and novel approaches to diseases.
#evidence-based medicine #EBM #quality control #functional health #evidence